Provider Demographics
NPI:1316275472
Name:JOHN MINOLI, MD, F.A.C.S., P.C.
Entity type:Organization
Organization Name:JOHN MINOLI, MD, F.A.C.S., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MINOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-459-3223
Mailing Address - Street 1:870 SEVEN HILLS DR
Mailing Address - Street 2:SUITE#101
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4377
Mailing Address - Country:US
Mailing Address - Phone:702-459-3223
Mailing Address - Fax:702-260-0275
Practice Address - Street 1:870 SEVEN HILLS DR
Practice Address - Street 2:SUITE#101
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4377
Practice Address - Country:US
Practice Address - Phone:702-459-3223
Practice Address - Fax:702-260-0275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9979208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVF42913Medicare UPIN